By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Young athletes and their parents often ask: what should we do first after an injury: ice or heat? The general answer is that you should apply ice for a short period after an injury, but some ongoing conditions (called ‘chronic’ conditions) can be helped by heat.
Recent Injury Or Swelling = Use Cold
After a recent injury such as an ankle or knee sprain, swelling may occur because of injury to the small blood vessels around the joint or muscle.’ Applying ice to an acute injury makes the blood vessels constrict and thus minimizes the swelling and pain. The sooner ice is applied on a recent injury, the more effective it can be. Heat has the opposite effect on the small blood vessels- it causes widening of the blood vessels and may lead to increased swelling. For that reason it is not recommended to apply heat to a swollen joint or recent injury. Swelling leads to stiffness and discomfort and may lead to a longer healing time.
The best and safest management of an acute injury follows the ‘RICE’ treatment. I’m sure you know it well:
- Ice’ (Applying cooling in some form)
- Compression ‘ (A light compression wrap to minimize swelling)
- Elevation (Elevates the injured body part above the level of the heart to help minimize the swelling)
Ice is usually applied for 15 to 20 minutes several times a day. Ice packs can be made from crushed ice in a plastic bag and even using frozen peas. The frozen peas work well in conforming to the body part, and are readily reusable. When icing for long or repeated applications, protect the skin with a towel to prevent skin damage.
Icing should generally be continued for at least 48 to 72 hours, as directed by a physician. Icing is also helpful in certain conditions that cause soreness after practice or games, such as elbow tendonitis, Osgood-Schlatter syndrome (front of the knee), or Sever’s syndrome (back of the heel).
Ongoing Muscle Soreness = Consider Heat
Heat treatments are usually reserved for chronic conditions, as heat tends to expand the small blood vessels and help relax and loosen tissues, as well as stimulate blood flow to the area. A good example of proper use of heat treatment is on a quadriceps muscle that is recovered from a quadriceps strain but stiff and not fully functional. Heating body parts can be accomplished with warm water jets (a Jacuzzi) or a hot moist towel. Commercially available topical creams and gels such as Icy Hot are popular in every training room in America to provide some warmth to stiff muscles. Heating pads tend to not conform to the body part, and have been known to cause blisters.’ It is important when doing heat treatments to never sleep on a heating pad or use the heat treatments for a prolonged period, this can cause skin irritation and blisters.
A popular training room method is to apply some warmth to stiff muscles in pre-exercise warmup to improve blood flow and then cool down with ice after the activity to minimize swelling. And if there is concern for swelling, use ice, not heat.